Environmental toxicants are increasingly linked to adverse birth outcomes such as low birth weight, preterm birth, birth defects and developmental delays. Inner-city populations are at higher risk for adverse birth outcomes and also are more likely to be exposed to environmental toxicants. Obstetric providers are seeking clarification about the true risks of many environmental exposures and what message they should deliver to their patients. Patients in this population are confused by the conflicting messages they receive from providers and peers about behaviors and exposures that could put their fetus at risk. The Institute of Medicine and the National Environmental Education and Training Foundation recommend the integration of environmental health concepts into all levels of medical and nursing education. In the proposed SBIR Phase II project called Managing Environmental Risks in Pregnancy, Vida Health Communications, Inc. will complete the development and evaluation of the web-based provider training and patient education multi-media prototyped in Phase I. The final products of this research will be (1) a cross disciplinary web-based training offering continuing education for obstetric providers serving urban populations, (2) an educational DVD in English and Spanish and group discussion guide for showing to patients in clinic and office waiting areas or in facilitated group discussions, (3) a library of colorful support materials in English and Spanish at appropriate levels of literacy for providers to print and distribute to patients made available both as electronic documents (pdf) and in preprinted form. The interventions will be evaluated using focus groups representative of the target audiences. Evaluators will use well-documented qualitative techniques to analyze focus group data. This project will advance the environmental health training of obstetric providers serving urban populations that may be at risk for exposure to substances that can harm their developing fetus. It will also provide much needed education, at appropriate literacy levels, for at-risk women about ways that they can moderate fetal exposure to environmental risks in pregnancy. Narrative: We are beginning to recognize the scope of environmental toxicants that urban-living pregnant women may be exposed to. Given the rapid development of a fetus, especially in the early months of pregnancy, avoidance of exposure is at present the most effective way to mitigate potential harm. This research will contribute to knowledge of how prenatal care providers can interest, inform and motivate pregnant women who likely bear the greatest risk of exposure, so they can protect the fetus and improve the chance of giving birth to a healthy, normal infant. [unreadable] [unreadable] [unreadable]